Journal of Asian Medical Students' Association

For, With, And Early Goal Directed Training vs Passive Therapy for Functional Independence of Infants with Cerebral Palsy: Systematic Review and Meta Analysis

2026-05-16T02:42:50+00:00

Background: Cerebral palsy (CP) is the leading cause of childhood motor disability, especially in LMICs. Early intervention is critical, yet the efficacy of goal-directed training compared to passive/standard therapies remains debated.

Objective: This study aims to evaluate the effectiveness of early goal-directed interventions on improving functional independence in infants and children with or at high risk of CP.

Methods: This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A comprehensive literature search was performed to identify randomized controlled trials (RCTs) comparing goal-directed training with passive therapy or standard care. Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data were synthesized using a random-effects model to calculate the Standardized Mean Difference (SMD).

Results: Five RCTs involving 302 participants were included. Meta-analysis revealed that goal-directed training showed a positive trend toward improved functional outcomes compared to passive therapy, although it did not reach statistical significance (SMD 0.19; 95% CI -0.09 to 0.47; p=0.1398). Heterogeneity across studies was remarkably low (I2 = 0), indicating a consistent intervention effect across diverse age groups and therapeutic modalities. Risk of bias assessment identified "some concerns" in three studies primarily due to missing outcome data, while two trials were rated as low risk.

Conclusion: Goal-directed training demonstrates a promising and consistent clinical trend in enhancing functional independence for children with CP. Despite the current lack of statistical significance, the negligible heterogeneity supports the integration of active, goal-focused exercises as a potentially effective and stable strategy for early neurorehabilitation.

Comparative Efficacy and Safety of Dual Orexin Receptor Antagonists (DORAs) Versus Z-Drugs for Insomnia in Older Adults : A Systematic Review

2026-05-29T00:30:21+00:00

Introduction

Insomnia affects up to 48% of older adults globally, often treated with Z-drugs that increase the risk of cognitive impairment and falls.1,4 Dual Orexin Receptor Antagonists (DORAs) offer a targeted alternative by specifically suppressing wakefulness-promoting pathways to minimize these adverse effects.7,8

Method

This systematic review of Randomized Controlled Trials was conducted using the PRISMA guideline with references found in multiple online databases including PubMed, ScienceDirect, Proquest and Sage Journals. The search strategy utilized a combination of keywords relevant to this study and the screening process was conducted by implementing exclusion and inclusion criteria developed using the PRISMA guideline.9 The studies recovered were then assessed by the Cochrane RoB 2 risk of bias tool.12

Result

Seven RCTs were evaluated. DORAs demonstrated significantly superior efficacy over Z-drugs, with Least Squares Mean differences of -6.7 and -8.0 minutes for 5 mg and 10 mg doses, respectively.14 Furthermore, safety analyses revealed DORAs had a significantly lower relative incidence of residual effects and cognitive impairment (<5%) compared to Z-drugs (>15%).16

Conclusion

Although both DORAs and Z-drugs help mitigate insomnia symptoms, DORAs have shown lesser adverse side effects in the treatment regimen, most notably in safety, DORAs have also shown lower levels of falls during treatment. Heterogeneity still is a limitation and restricts data power, standardized studies are needed to show a more comprehensive outcome in studies.

Efficacy of Complementary Nutritional and Herbal Interventions on Peripheral Inflammatory Biomarkers and Clinical Outcomes in Parkinson’s Disease: A Systematic Review

2026-05-18T00:01:47+00:00

Background: Dopaminergic neuron loss, neuroinflammation, oxidative stress, and disruption of the gut microbiota are all linked to Parkinson's disease, a progressive neurodegenerative condition. Probiotics and synbiotics are examples of non-pharmacological adjuvant treatments that have shown potential advantages through modulation of neurotrophic and inflammatory pathways, while results are still mixed.

Purpose of Study: The purpose of this systematic review was to evaluate the impact of non-pharmacological adjuvant therapy on systemic inflammatory biomarkers, neurotrophic factors, metabolic pathways, and clinical outcomes in patients with PD.

Methods: Based on PRISMA 2020 guidelines, this study was conducted and the protocol was registered in PROSPERO (CRD420261395485). Literature from PubMed, ProQuest, Science Direct, Springer Nature, and Cochrane Library was screened according to inclusion and exclusion criteria. A total of four RCT were included in the analysis

Results: Four randomized controlled trials on probiotics, synbiotics, Zishen Pingchan Granule, and vitamin D3 supplementation in Parkinson's disease were included. The studies showed improvements in inflammatory and neuroprotective biomarkers such TNF-α, IL-6, CRP, BDNF, and α-synuclein, as well as selected motor and non-motor outcomes. No significant treatment-related adverse effects were regularly reported.

Principal Conclusion: Complementary nutrition and herbal therapy could provide anti-inflammatory and neuroprotective benefits in Parkinson's disease. However, the current information available is limited by small sample numbers and methodological heterogeneity. Larger standardized trials are needed to confirm the clinical efficacy and long-term therapeutic potential.

Keyword: Parkinson’s disease, Placebo, Non-Pharmacological interventions, Inflammatory biomarkers, Neuroprotective biomarkers

Molecular Pathogenesis of Valproate-Induced Neural Tube Defects: A Systematic Review of Apoptosis, Folate Pathways, and Gene Expression Dysregulation

2026-05-16T02:51:13+00:00

Background: Significant morbidity and mortality are related to neural tube defects (NTDs), which are severe congenital malformations brought on by failure of neural tube closure during early development. Through several teratogenic processes, valproic acid (VPA), a commonly used antiepileptic treatment, is strongly correlated with a higher incidence of NTDs.

Purpose of Study: This review attempts to synthesize current research and integrate molecular mechanisms associated with VPA-induced NTDs, which are often studied separately.

Methods: Based on PRISMA 2020 guidelines, this study was conducted and the protocol was registered in PROSPERO (CRD420261384605). Literature from PubMed, ProQuest, Science Direct, and Wiley was screened independently by all the authors according to inclusion and exclusion criteria. A total of seven studies were included in this systematic review. A proper assessment of Risk of Bias was conducted using the Cochrane RoB 2.0 and Modified SYRCLE's RoB.

Results: The results showed that valproic acid (VPA) causes neural tube defects (NTDs) via a variety of pathways, including oxidative stress, apoptosis, folate-pathway dysregulation, epigenetic modification, and retinoic acid signaling disruption. Genetic susceptibility affected teratogenic outcomes through differential regulation of folate-related and anti-apoptotic genes, whereas VPA exposure changed the expression of genes involved in neurulation and embryonic development. Additionally, new research indicated that by inhibiting apoptotic pathways and reducing the prevalence of NTDs, maternal immune activation can reduce the teratogenic impacts of VPA.

Conclusion: Developmental signaling dysregulation and host susceptibility variables interact complexly in VPA-associated teratogenicity. To support better preventive and therapeutic strategies for pregnant individuals in need of VPA treatment, further mechanistic research is required.

Age-Dependent Effects of Chronic Unpredictable Stress on Male Reproductive Organs in Rats

2026-06-01T23:04:40+00:00

Context: Stress occurs in response to external harmful factors and can have detrimental effects on organ functions.

Aims: Some suggest that stress has major consequences for the male reproductive system and infertility. The present study focused on the effects of Chronic Unpredictable Stress (CUS) on serum testosterone level, tissue Promyelocytic Leukemia Zinc Finger (PLZF) protein, and histopathological changes in testicular tissue.

Methods: In this study, we separated 32 Wistar rats into four groups (group 1: young control, group 2: young stress, group 3: old control, and group 4: old stress). The stress groups underwent CUS, rats in the stress groups were subjected to one unpredictable stressor daily for eight consecutive weeks to simulate chronic stress exposure. After the experiment, we measured serum testosterone using the Enzyme-Linked Immunosorbent Assay (ELISA) test, PLZF changes in testicular tissue by immunohistochemistry (IHC), and testicular tissue changes by hematoxylin and eosin staining (H&E). We analyzed data by two-way ANOVA and the Bonferroni supplementary test.

Results: The results showed that serum testosterone levels in the stress groups were significantly lower than in the control groups. Also, the population percentage of PLZF-expressing cells in testicular tissues was lower in the stress group. Histological results showed that spermatogonia populations decreased in both stress groups. We saw sloughing of seminiferous tubules in the old stress group which wasn’t seen in the younger ones (P <0.05).

Conclusions: CUS reduces testosterone production rate, similar to testicular tissue disorders, so it would have damaging effects on fertility.